What is the role of MRA in the workup of vertebral artery dissection (VAD)?

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

MRA can identify abnormalities that are characteristic of the disturbed arterial flow seen in VAD. These include the presence of a pseudolumen and aneurysmal dilation of the artery. [7]

New generation MRI and MRA appear to be as sensitive as cerebral angiography for the detection of VAD, although they probably have equivalent specificity. [8, 9, 10, 11, 12, 37]

Cerebral angiography may still have a role when clinical suspicion is high but MRI/MRA has failed to isolate the lesion. In these situations, the choice can be made between serial noninvasive imaging (if symptoms are suggestive of VAD) or invasive angiography (if the patient is a candidate for revascularization and might benefit from simultaneous diagnosis and therapy).


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